Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study.

PURPOSE: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. METHOD: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n = 16) received Lokomat therapy twice a week, combined with three times 30 min a week of conventional overground therapy. The second group (n = 14) received conventional assisted overground therapy only, during a similar amount of time (3.5 h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. RESULTS: Patients showed significant (p < 0.05) gains in walking speed, other walking- and mobility related tests, and strength of the paretic knee extensors relative to baseline at all assessments. However, there were no significant differences in improvements in any of the variables between groups at any time during the study. CONCLUSION: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone. Implications for Rehabilitation Recovery of walking after stroke is important. Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices. Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies. RESULTS of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury.

The objectives in this study were to investigate the effect of robot-assisted gait training on cardiorespiratory fitness in subjects with motor incomplete spinal cord injury and document the exercise intensity of robotic walking in comparison with the recommended guidelines. Ten patients followed a 24-session training program with a robotic gait orthosis in addition to physiotherapy sessions completed within 10 to 16 wk. Cardiorespiratory fitness was determined in a graded arm crank exercise test before and after the training program. To assess the intensity of robot-assisted walking, oxygen consumption (VO2) and heart rate (HR) were measured during a training session early in and at the end of the training program, and exercise intensity measures (percentage of VO2 reserve [%VO2R], percentage of HR reserve [%HRR], and metabolic equivalents [METs]) were calculated. Whereas no changes were found in peak VO2, the resting and submaximal HR at a constant work load were significantly lower after training. Most subjects exercised at low intensity (<30%VO2R, <30%HRR, <3.0 METs), and only two subjects exercised at moderate intensity (>3.0 METs). In spite of the low exercise intensity of the training program and no changes in peak VO2, robot-assisted gait training induced some improvement in cardiorespiratory fitness, as suggested by lower resting and submaximal HR values.

Robot-assisted walking vs overground walking in stroke patients: an evaluation of muscle activity.

OBJECTIVE: There is increasing evidence that robot-assisted treadmill training might be useful for gait rehabilitation after stroke. The aim of this study was to evaluate the muscle activity of stroke patients during robot-assisted walking and overground walking, and of a group of able-bodied subjects during overground walking. DESIGN: Case-control observational study. SUBJECTS: Ten stroke subjects and 10 able-bodied control subjects. METHODS: Electromyography measurements of 7 lower-limb muscles were made in 3 trials: robotic walking, in which stroke subjects walked in a robot-assisted gait orthosis; overground walking for the same group of stroke subjects; and overground walking for control subjects. Trials were compared with respect to electromyography amplitude of selected leg muscles. RESULTS: Higher muscle activity during overground walking compared with robotic walking was found in several muscles during several phases of the gait cycle. A significant trial × leg interaction revealed smaller differences in muscle activity between the paretic and non-paretic leg during robotic walking compared with overground walking. Furthermore, the muscle activity pattern was not significantly different between control walking and robotic walking, while it was different between control walking and overground walking. CONCLUSION: Despite lower muscle activity, robot-assisted treadmill training may elicit a more symmetrical pattern of leg muscle activity, which approaches that of able-bodied individuals.

Exercise intensity of robot-assisted walking versus overground walking in nonambulatory stroke patients.

It has been suggested that aerobic training should be considered in stroke rehabilitation programs to counteract detrimental health effects and decrease cardiovascular risk caused by inactivity. Robot-assisted treadmill exercise (using a Lokomat device) has the potential to increase the duration of walking therapy relative to conventional overground therapy. We investigated whether exercise intensity during Lokomat therapy is adequate to elicit a training effect and how assistance during walking in the Lokomat affects this exercise intensity. Ten patients with stroke (age 54 +/- 9 yr) walked in both the Lokomat and in a hallway. Furthermore, 10 nondisabled subjects (age 43 +/- 14 yr) walked in the Lokomat at various settings and on a treadmill at various speeds. During walking, oxygen consumption and heart rate were monitored. Results showed that for patients with stroke, exercise intensity did not reach recommended levels (30% heart rate reserve) for aerobic training during Lokomat walking. Furthermore, exercise intensity during walking in the Lokomat (9.3 +/- 1.6 mL/min/kg) was lower than during overground walking (10.4 +/- 1.3 mL/min/kg). Also, different settings of the Lokomat only had small effects on exercise intensity in nondisabled subjects.